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graciouslittlethings · 7 years

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5 Friendly Tips for VBAC Mothers

From the start, I have always wanted to go through the experience of delivering naturally. Unfortunately, I was not able to do so with my first pregnancy as Dozer was a breech baby. With the help of my excellent gynaecologist, I was finally able to realise my dream of delivering naturally the second time around! If you’re a hopeful VBAC mother, just as I once was, here are 5 tips which I’d like to share from my personal experience!

1. Find a gynae whom you can trust 100%

It really is very important to find a gynaecologist whom you trust utterly, because childbirth is a very important event in your life. I have a very professional, excellent and competent gynaecologist and I trust her 100%.

I’ve heard many stories about how mothers who have delivered via Caesarean are subsequently advised by their gynaecologists to opt for Caesarean instead of attempting VBAC. While I’m sure that most gynaes do have their patients best interests at heart, my suggestion to you is to always try for another opinion if you really, really wish to attempt VBAC.

When my gynae recommended that I plan for my Caesarean date as Dozer wasn’t turning, I had my moments of doubt.

Did I wonder if my gynae was intentionally pushing me towards Caesarean?

YES.

Did I doubt her advice?

YES.

At the end of the day, I realised, however, that whatever doubts I had were actually an emotional reaction as a result of my disappointment at being unable to deliver naturally. So I trusted my gynae and went ahead with C-section.

Trust isn’t just about how competent your gynae is. There has to be rapport between the both of you. When I was pregnant with Baby Dino, my gynae remembered how strongly I felt about delivering naturally and she promised that she would do whatever she could to help me with my VBAC attempt.

2. Don’t make assumptions based on the interval between your pregnancies

The age gap between my 2 boys is exactly 2 years. I’ve had people tell me that that is too short an interval in which to have a VBAC.

All I have to say is, don’t assume!

Always consult your gynae and listen to what they have to say. In my case, my scar had healed well, I had had no other issues so, VBAC was a very realistic possibility despite the seemingly “short” interval between my pregnancies.

3. Pregnancy complications don’t mean that VBAC is no longer an option

I don’t think I’ve ever mentioned this before but I like to think of Baby Dino as my miracle baby. Shortly before I completed my first trimester, I had heavy bleeding for many days. I was immediately ordered to take bed rest and even had to take medical leave from work for a week (I was still in an employment back then).

After examining me, my gynae warned me to be prepared for the worst, as my situation did not look too optimistic. Fortunately, Baby Dino made it and despite the early scare, VBAC still continued to be an option for me! Definitely my miracle baby. :)

4. Do expect additional precautions

Despite our medical advancements, VBAC still carries additional risks. One of the key risks would be uterine rupture where the uterus tears open along the scar line from a prior C-section. While this risk is rare, it is still a risk and because of that, I was requested to check in to the hospital from the moment I had contractions with intervals of about 15 to 20 minutes.

5. It all comes down to you and your gynae

This may be funny but I think women who have gone through a C-section are at a greater disadvantage because we already know how easy delivering via C-section is! I kept having to battle the desire to take the easy way out when the contractions were at its peak and I was really exhausted from pushing.

It came to a point where I actually wanted to tell my gynae, “I give up!!! Let’s just go for a C-section!” but thankfully, both my determination and my excellent gynae made sure I made it through naturally.

In the first few hours immediately after delivering Baby Dino, I actually told myself that I’d opt for a C-section the next round, and save myself all that pain and pushing but over the next few days, the recovery was so swift compared to when I had my C-section, that I changed my mind!

Since then, I have become a strong advocate of delivering vaginally. Having gone through both C-section and natural birth, I have to say natural birth is indeed a very unique and one-in-a-lifetime experience!

As an ex-expatriate and management consultant in an international firm, Grace was a career-minded woman on a fast-track path in the corporate world. The birth of her first child changed her perspectives in entirety, and she made the life-changing decision of becoming a stay-at-home mum. In addition to being one of Malaysia’s top digital influencers on Nuffnang’s Bloggerati list, she is a Dr. Sears Certified Health Coach and also runs children-related businesses (links available below).

- Facebook: facebook.com/graciouslittlethings

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#vbac #experience #tips #sharing #vaginal birth after caesarean #tolac #caesarean #which one

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therusticmama · 6 years

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Birth story time

So at 8am March 23rd I got out of bed in the morning because I experienced a little leaking. I assumed it was discharge and just changed my pantry liner. A little later it turned to gushes with a slight almost bleach smell. I realized there’s a real good chance it was my waters. I wanted to get checked at base medical before heading out to my actual hospital 45 mins away. She warned me if I were to go there they would admit me and I wouldn’t be able to tolac. So we drove out to our hospital, dropped kinsley off with our good friend and trucked along. We get there they of course check for amniotic fluid which at this point we all pretty much knew it was (side note depends came in handy for this because I had leaked completely through my clothes earlier) she checked me and I was at 2 cm and the test came back positive so I was admitted. There is only 3 doctors here that tolac and I was lucky they were on call Saturday and Sunday. So they get me in my room and get me on pitocin. Emmie was at -3 station still and seemed to not very much want to drop. My contractions didn’t seem strong enough and it was beginning to look like this tolac wasn’t going to happen. They installed internal monitors to check my actual contraction strength and one on the baby’s head to keep track of her heart rate. They slowly increased my pitocin and boy did I feel that. My contractions were strong and very consistent. They gave me morphine but it didn’t take any of the pain away so I ended up begging for the epidural. My epidural experience wasn’t great. Took him a couple tries to get a good spot but once he was done and that medicine kicked in boy I had a good sleep. Some point during my sleep the doctor had come in and said due to babie’s heart rate decelerations we had to scrap the tolac and do another c section. I had a great c section. I’m very sore but so happy my baby is here and safe. I’m very appreciative of this doctors for letting me tolac even if it wasn’t meant to be

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mcatmemoranda · 1 year

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TOLAC - Trial Of Labor After Caesarean

Pitocin and Cook balloons are ok for TOLAC, but prostaglandins increase risk of uterine rupture!

#TOLAC

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drokelley-blog · 5 years

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Okelleys in Tenwek 2019

Since returning from Africa, my wife Dana and I have found it difficult to respond when asked how our trip was. “Good” or “great” is the usual one-word response but many more adjectives come to mind, as it was a trip filled with a mixture of different encounters, experiences, and emotions. And somehow just one or two words do not suffice. It would definitely be accurate to say that it was eye-opening.

We came to this particular place because of the Many family. Most folks know of our long-term friendship with them, so I won’t elaborate here, but it was wonderful to visit them and experience what life is like for them at Tenwek. I believe they are where the Lord wants them to be, but like life anywhere, Tenwek has its share of happiness and hardships. We had learned what we could ahead of time about Kenya and Tenwek from materials provided by Samaritan’s Purse who took care of all the logistics of our trip, as well as from conversations with the Many’s and also from our daughter Claire, who had visited with them for several months in 2015. But nothing really could prepare us for a place that is so different from our everyday experience back home.

Our drive to Tenwek hospital took us 4-5-hours from the airport in Nairobi on a rough road that had become paved only 5 years prior. Tenwek is located in the rural highlands of southwestern Kenya which has no large or modern cities nearby, yet the population in the general area is quite large. In addition, patients are referred from long distances for treatment at Tenwek which is one of Africa’s largest mission hospitals. As you might expect in a developing country, the people there do not have most of the things we take for granted. Clean water, reliable electricity, passable roads, and adequate sanitation are still hard to come by there, and there would be no access to adequate healthcare without Tenwek Hospital. It is a 300-bed teaching facility with a long evangelical-centered mission to provide the best healthcare possible. 72 of those beds are designated to the maternity service, where I spent my time working as a member of the “OB service”.

Most women in this area give birth at home. There are smaller clinics in the area which provide very basic care but lack the ability to handle most emergencies. So, women who come to Tenwek either arrive from their village, or are referred by these smaller clinics with little or no prenatal care and are either high-risk or suffering some sort of complication related to pregnancy or childbirth. The maternity service delivers about 3-400 babies per month, and also receives a large number of patients who have delivered elsewhere and are experiencing complications. The single delivery room holds 3 delivery beds or “couches” and is used for deliveries, triage, and labor exams. There is a 5-bed “labor” ward for laboring patients, inductions (of which there were usually 4-5 daily), and any high-risk antepartum patients. Of course, this ward stays full and often spills over to the other rooms on the unit, which normally accommodate lower risk antepartum, postpartum and post-operative patients. Healthy newborns stay with their mothers. Mothers whose babies are in the neonatal intensive care unit (NICU) stay until their babies are discharged. The NICU has a capacity of about 45. So, the halls are normally crowded with patients, visitors, and staff, and it is not unusual to have 2 mothers assigned to the same bed or 2 babies assigned to the same isollete due to overflow. There is one O.R. in maternity for cesarean sections, or other minor procedures, but it is only available from 9 AM to 4 PM. Outside these hours an emergency cesarean section must be done in the main O.R. or “theatre”, which is in another building.

To say that the conditions in the hospital are different than what I normally have available at home would be an understatement for sure. That being said, Tenwek provides excellent care for maternity patients considering their limited resources. Nurses manage all labor patients and perform all uncomplicated vaginal deliveries. They have medications such as Pitocin and magnesium sulfate for inductions and treatment of preeclampsia but do not have infusion pumps. They also have available the usual medications to treat postpartum hemorrhage. There is no continuous fetal monitoring available including for patients on Pitocin or with other high-risk indications. There is no epidural service available. Intermittent fetal monitoring and a vaginal exam (VE) usually are performed by the nurses every 4-6 hours on all labor patients. Inductions are performed with misoprostol, Pitocin or Foley balloon. Patients are not screened for group B strep but antibiotics are available to treat infections and are given preoperatively. Patients with one previous cesarean are allowed to “TOLAC” (trial of labor after cesarean). Everything is in short supply, and items we normally consider disposable in the U.S. are “repurposed” until they are no longer usable, such as Bovie pens and laparoscopic trocars. O. R. packs included cotton drapes and towels, which are sterilized and reused.

2-3 nurses cover active labor patients and inductions in 12-hour shifts, and 2-3 to cover postpartum, gyn post-op, etc. There are another 2-3 in the nursery caring for the newborns who are sick or premature. As I mentioned, the nurses perform the labor checks, non-stress-tests (NST’s), and routine deliveries and call the intern or physician for complications. The only patients directly under the supervision of the OB team are antepartum admissions, post-surgical patients, and patients with complications. During my time there were 2 medical officers (completed one year of post-medical school training), and 1-2 Ob- gyn’s, depending on who is available on a given day. The Ob-gyn doctors are currently Americans including Dr. Cheryl Cowles and Dr. Angela Many, but there is a new Kenyan Ob/Gyn starting soon who had just completed residency training in Uganda. There were also 2 clinical interns and 3 medical interns. Clinical interns have similar training and background to physician assistants in the U.S., whereas medical interns have completed medical school and will be medical officers at the end of their internship. Night and weekend call are divided among the Ob gyn doctors, medical officers, and family practice residents; however, the Ob doctors are always on the hook if needed to help with complicated cases. The interns take call also, and work pretty much like interns in our training programs back home, which is to say “hard”. On the OB service during my visit there was also a 1st year family practice resident and a 2nd year surgery resident. The daily rounding list included post-op, antepartum, ICU, and any other patients with complications and usually had 40 or so names on it. There were usually 10 or more new admissions every day. Many patients presented with “LAPS” (lower abdominal pains) and were full-term or post-dates based upon their last menstrual period but had no prenatal care and no ultrasound to confirm their due-date. There is one portable ultrasound machine on the maternity ward used by OB physicians and medical officers for performing scans. Typically, these patients would receive an ultrasound, NST, and a VE and were either induced, kept in the hospital for observation, or discharged undelivered and given a follow up appointment in the clinic in 1 week with the prayer that they would keep that appointment or return in labor and deliver a healthy baby.

So, between daily rounds, clinic, scheduled surgeries (non-emergent surgeries are booked on Tuesdays and Thursdays in the main theatre), new admissions, and emergencies, the OB service kept very busy. In fact, the number of patients and seriously ill patients was more than I had ever encountered in one place. The diagnoses on our rounding list resembled the contents section of an obstetrical text book. Tenwek mothers are also chronically anemic and that is a bad thing in obstetrics, where the potential for rapid blood loss is high. We ordered more blood transfusions during my 2 weeks than I have in over 10 years and possibly my entire career. Family members were required to donate, and nursing students, medical staff and missionaries were also called upon often to give blood in order to address the critical need. OB patients occupied 3 out of the 6 ICU beds in the hospital the first week I was there. Unfortunately, 2 of the 3 did not survive their illnesses. We also had several babies born premature and several stillbirths and most of these outcomes could have been prevented if they had gotten to the hospital earlier in their illness. I often thought of how back in Knoxville I would transfer such seriously ill or preterm patients somewhere else for their care, but at Tenwek there is no such thing as “somewhere else”. I took call 4 nights in 2 weeks including an entire weekend. I lied awake at night waiting for the beeper to go off and it usually did. I was able to take call from “home” (our small apartment at the guesthouse which is a 5-minute walk away), but they were not particularly restful nights.

Tenwek is a teaching hospital. So, we would begin “teaching” rounds every morning between 7 and 8 am, just like back in medical school and residency. This took some getting used to since I had not done this in 30 years, but I did enjoy the interaction with clinicians in training. Of course, acting as first assistant and helping an intern learn to perform a cesarean section requires patience, but this is critically important at Tenwek as the goal is to train more Kenyan nationals to provide for the healthcare needs of their country. There were daily conferences such as grand rounds, and “M&M” (morbidity and mortality), just like in any traditional academic setting. But there is also a clear spiritual emphasis here that cannot be missed; one that is related to the spiritual well-being of the interns, residents and ultimately the patients. The motto at Tenwek is, “we treat, Jesus heals”. Prayers are said for the patients before rounds and before every surgery. These prayers became a great source of comfort and strength to me personally as we cared for many seriously ill patients. In addition, a morning team devotion preceded rounds each day, and there is a devotional meeting for the entire medical staff every Wednesday morning in the hospital auditorium. In the evenings there are small group meetings for Bible study and fellowship in the homes of the missionaries for medical staff, interns, and students.

As you might gather from my description, the daily conditions, work load, and severity of illnesses which I encountered during my time at Tenwek was almost overwhelming. And yet I was humbled and amazed by the ability of the medical staff and missionaries to carry on tirelessly with great compassion and concern for their patients. Before the trip, I read a book entitled “Miracle at Tenwek”, which describes how the mission of Tenwek began and has since remained focused on seeking God’s leadership in sharing the gospel through medical missions. I believe that the success of Tenwek is due to the fact that the focus is still the same today. “They still do it right”, was an assessment I heard from a returning missionary in describing Tenwek in it’s mission to train individuals to provide compassionate care for the physical as well as the spiritual need of their patients.

So, to find one word to describe our trip to Kenya is difficult. It was a trip filled with joy, kindness, and beauty as well as suffering, sorrow, and poverty. But if I had to choose one word, I would use the word that another visiting physician kept saying: “amazing”. It’s a good word to describe Africa, Kenya, the Kenyan people, and the missionaries who work at Tenwek. But it is also a great word to describe God, whose hand we saw in every aspect of our trip.

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wiwsport · 2 years

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am-3w · 3 years

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31+4

FINALLY. Finally an OB/Widwife who will fucking listen to me!

I had my first appointment with this new practice, which consists of an OB and two midwives. All of which have rights at my hospital. I asked a million questions and she did nothing but confirm everything I had been begging people to listen to.

I am NOT at any higher risk than any other VBAC/TOLAC. NONE of the issues I had with Hayden are reoccurant! And none of the bullshit statistics I was given are true. She fully supports me at least trying, including assisting me with trying as naturally as we can. The ONLY difference statistically than someone who HASNT HAD A C-SECTION is the .6 - 1.0 chance of uterine rupture.

She even referred to this birth as a healing process after my last. We discussed informed consent and that we will have open communication before any decisions or if problems are upcoming.

Baby girl is actively measuring large, about a week and a half ahead along with fundal measurement, which matches. If my next appointment I'm still measuring the same, we'll be referred to another growth scan where they may consider changing where I hit "full term".

We most likely are looking at a voluntary induction at 38-39 weeks if I don't go by then. I expressed my concern for Pit to Distress with Hayden and she pretty much told me while she can't technically comment on it, She's looked over my medical report and doesn't disagree. Our only option for induction is pitocin but it'll be different as there won't be anything hidden from me this time.

Red raspberry leaf tea is cleared as of 36 weeks. Dates are encouraged. She said yoga and lots of water is all she wants me to focus on right now. I have another appointment in 2 weeks with the OB. I am so fucking relieved after today and truly believe my body can do this. 💪❤

#personal

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juniperpublishersanatomy-blog · 5 years

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Approach to Lower the Caesarean Delivery Rate - Preventing the First Caesarean-Juniper publishers

Of late there has been a great buzz about the abnormal rise in the caesarean rate in most of the countries, raising a concern. In some this is more apparent under the private health care facilities. In fact this upward trend has been observed since the beginning of this century. As per recent data over 30 % women are experiencing a caesarean delivery (CD). In 2014, in the United States, 32.2% of pregnant women delivered through this bypass, accounting for over one million surgeries [1]. This upward trend to rely on the surgical delivery during the closing years of the last century did not convert into better outcomes for the mother and foetus as no clear evidence of concomitant decreases in maternal or neonatal morbidity or mortality was presented. With the OBG professional bodies acknowledging the need to address this burgeoning trend for CD, which may be seen as commercially/profit driven, a new set of guidelines have been framed to highlight the need to prevent first CD. The CD once done would make the next a likely repeat CD, if the TOLAC/VBAC does not have a favourable outcome. Is CD being over used? Has it become a tool for commercial exploitation? OR is there a gap in training of the obstetricians to be skilful to handle abnormal presentations /prolonged labour whereby CD is chosen as an escape route? It is not easy to determine and specify an ideal CD rate as it varies according to multiple factors. The most common indications for caesarean delivery include labour abnormalities, variation in the foetal heart rate tracing, foetal mal position /mal-presentation and placental factors. It is vital not to ignore the effects that a primary CD will have on the subsequent pregnancies and delivery choices. To address this concern the Department of Health and Human Services in the United States have set a target to lower the CD rate to 23.9% by 2020 [2]. This dramatic rise in the rate of caesarean delivery is due in part to an increase in frequency of primary caesareans, when over 90% would require a repeat section. It brings forth two major concerns- one, the increased risk of maternal complications in the index operative delivery, and secondly the impact on the future deliveries, like encountering peritoneal adhesions increasing the risk of surgical trauma to the bowel and bladder, abnormal placentation like placenta praevia/accreta, and uterine rupture with consequent catastrophic outcomes for the mother and the foetus due to excessive haemorrhage [3]. Safe reduction of the primary caesarean delivery rate will require varying approaches for various indications, depending upon individual preferences or institutional guidelines. Increasing reliance on non-medical interventions like external cephalic version for breech presentation and a trial of labour can effectively contribute to reducing primary caesarean birth rates. Given the risks associated with the initial caesarean and its implications for subsequent pregnancies, the most effective approach to reduce overall morbidities related to caesarean delivery is to avoid the first caesarean. While professing this approach it is pertinent that the overall maternal and perinatal morbidity and mortality is maintained at the lowest possible levels achievable.

Analysing the Indications for Primary Caesarean Delivery

A view to ascertain the preventable ones could be the first step in reducing the primary caesarean delivery rate. Barring the absolute indications for caesarean like major degree of placenta praevia, cord prolapse etc. some of the indications, as mentioned below, can be considered as modifiable: Mal-presentations, (Scope of ECV), Multiple gestations, Hypertensive disorders (Trial of Labour), Maternal request, Arrest of labour-First or Second-stage (clearer identification of Active phase of labour), Non-reassuring foetal heart rate (amnio- infusion may be an option) From the list above, it is obvious that the interpretation by the caregiver can be the deciding factor, hence considered modifiable. A meaningful avoidance in each individual indication will finitely contribute towards an overall reduction in the primary caesarean delivery rate and all unneeded surgeries [3]. Another trend worth highlighting is the perception among both the patients and the obstetricians regarding the safety of a vaginal delivery vis a vis caesarean delivery. An undue concern about vaginal delivery combined with relative indifference regarding the risks of surgical intervention based on improper or inadequate clinical evidence makes caesarean delivery a likely outcome. Their respective attitudes are the other potentially modifiable factors. Promoting a safe vaginal delivery by placing the facts in an unbiased and professional manner will improve the vaginal delivery rate. Nonetheless, likewise when the caesarean delivery is indicated the patient should be explained the risks of the surgery as well as the short and long term effects of the choice made. If it is made mandatory to list the modifiable indications for CD as “non-indicated Caesarean”, the rate of primary caesarean may see a downward trend as the professional audit, if performed regularly as an institutional requirement, can act a deterrent for such unneeded caesareans [4]. The institutional guidelines can be more specific and consistent with the accepted indications for a caesarean. Those performed under the labels of “ non-reassuring foetal tracing’, ”failed induction”, “labour arrest” etc. if subjected to stringent scrutiny, to analyse and provide relevant feedbacks, can be useful to reduce the rate of primary caesarean [5].

Achieving higher rate of vaginal delivery

During the routine antenatal visits it should be impressed upon the patient, especially the primi-gravidas that a vaginal delivery is a natural birth process and she should be encouraged to seek her answers to any queries. Likewise, conducting the antenatal classes where antenatal exercises are explained and practised so as to prepare the woman for a vaginal delivery need to be implemented. The discussion with the attending physician about the management of the pregnancy and delivery can have a profound effect on the choice of route of delivery. The discussion regarding the practice of presence of the partner in labour suite, place of the neuro-axial anaesthesia during labour, indications for induction/augmentation of labour and evaluation of foetal status during labour may prove to be relevant for a successful vaginal delivery.

Induction of Labour

While analysing this trend of the increase in caesarean deliveries, the impact of the current practice of pro-active inductions of labour cannot be overlooked. The protagonists for induction of labour have a view point of theirs. Also there has been ample data suggesting that successful vaginal delivery outcome is lesser in induced labour than spontaneous onset labour, more so if the induction is done in nulliparous women with low Bishop’s score. Induction of labour should involve a proper selection of patients where successful outcome is more likely, and to achieve this there should be clearly defined protocols in place specifying the definition of favourable cervix, options for cervical ripening, definition of failed induction and active phase of labour. Once a decision for Induction has been taken based on a relevant indication, the status of cervix should be the next consideration because an unfavourable cervix can have a negative impact on the progress of labour thus potentially increasing the likelihood for a caesarean delivery. However this should not stand in the way of choosing to induce. The documentation of the Bishop’s score as a component of risk-benefit assessment will bring about the relevance of medically-indicated induction. A Bishop’s score greater than 8 generally confers the same likelihood of vaginal delivery with induction of labour as that following spontaneous labour, and thus has been considered to indicate a favourable cervix [6] Conversely, a Bishop’s score of less than 6 suggests an unfavourable cervix and counts as a higher risk for a caesarean delivery. The use of cervical ripening agents is not shown to reduce the likelihood of caesarean delivery but can affect the duration of labour. The intent of induction should be to achieve a vaginal delivery, and adequate time should be allowed for the progress of labour to be assessed, provided the maternal and foetal condition is stable. Using well defined criteria to determine failure of progress or failure of induction will help eliminate unnecessary caesarean deliveries. The diagnosis of failed induction should be reserved for those women who fail to develop 3 contractions in 10 minutes and no change in cervical status after at least 24 hours of oxytocin administration, with artificial membrane rupture if feasible. Studies have shown that in women undergoing labour induction over half of them had prolonged latent phase for at least 6 hours, and another nearly 20% with as long as 12 hours or longer [7]. In another multi-centre study, successful vaginal delivery was achieved in nearly 40% of the women still in latent phase after 12 hours of oxytocin and membrane rupture. This data suggests that induction should not be defined to have failed in the latent phase unless oxytocin has been administered for at least 24 hours, or for 12 hours after membrane rupture [8,9]. Individualising the management for each case should be the guideline for induction.

Management of Labour

Some authors have eluded to the observation about the style of management of labour could also be a factor driving the increased caesarean rate. The diagnosis of prolonged labour vs arrested labour may be differently applied across the various facilities or could be dependent upon the expertise and the experience of the attending physician/midwife resulting in surgical intervention. Probably it’s time to revisit our understanding of mechanism of labour. The latent phase does not much vary between the nulliparous and multiparous women in labour, while the accelerated phase during the active phase shows a visible difference between these gravidas. The new guidelines from The American College of Obstetricians and Gynaecologists and the Society for Maternal-Foetal Medicine recommend that the active phase of labour should be considered after a cervical dilatation of 6 cm, which if applied in practice would eliminate those cases where the arrested labour has been diagnosed after failure to progress beyond 4-5 cm dilatation [10]. This has been seen more among those who check into the delivery suite in early labour, when the cervical dilatation may be just 3 cm or so, and may take between 6-7 hours for the changes to occur, resulting in diagnosis of arrested/protracted labour with the anticipated consequences [11].

Analgesia during labour

Use of epidural analgesia prolongs the total duration of labour. On the benefit side a good analgesia encourages a woman in labour to persist with natural process of delivery thus obviating surgical intervention. The practice of neuraxial analgesia should not be delayed or denied.

Operative vaginal delivery

It is a well documented fact that where operative vaginal deliveries are resorted to more often it results in reduced caesarean rate. On the contrary the reverse is equally relevant. The training for the use of the vacuum or forceps should be given the needed priority [12].

Foetal status during labour

Electronic foetal monitoring (EFM) remains the mainstay for evaluating the foetal status during labour. The option of the continuous monitoring or intermittent auscultation does not alter the outcome in the low risk pregnancies. Some studies have, however, linked continuous EFM to higher caesarean rates as well. This may be related to an inter observer variation in interpretation.

Summary

In summarizing, it can be stated that there are many factors that can be contributing to the primary caesarean rate. Identifying the modifiable factors and addressing the issues is the first step to reduce the overall caesarean rate in the future. The cascading effect of caesarean rate of over 30% can be detrimental for the health service facilities both in the monetary as well as human factors (affecting both the patient and the physician). It is imperative to acknowledge this concern and bring out requisite strategies/ guidelines that address it.

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themidwifeisin · 8 years

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I had a really traumatic experience with my C-section with my first baby. I'm now pregnant with my second child, and my doctor is saying that another C-section will be the safest option for me and baby, but I am terrified. I haven't told my doc about how traumatic my last one was yet. I am wondering.. is it possible to be put all the way under for a C-section? Am I allowed to ask for that? I can't stand the thought of being conscious for another C-section.

First of all, I’m so sorry to hear how traumatic that birth experience was for you. I hope you’ve been able to find some peace, and that you can look forward to this coming birth with the excitement that you deserve.

One thing to consider: I know nothing about why you had a cesarean birth with your first, and I have no idea why your provider is recommending a cesarean birth with your second. However, if you are interested in trying a vaginal birth with this baby, I recommend asking a few more questions to your provider:

Why do you think I need a cesarean with this pregnancy?

What is the American College of Obstetricians & Gynecologists recommendation about repeat cesarean births?

What are my risks with a Trial of Labor after Cesarean? What are my risks with a Cesarean Birth?

Check out ICAN and investigate a little bit whether or not it actually makes sense for you to have a repeat cesarean. Sometimes it’s the safest thing, sometimes it ISN’T.

When it comes to anesthesia for cesareans, general anesthesia (putting someone completely to sleep) is only ever used in an emergency, because the risk to the birthing parent is too great.

Not knowing what was so traumatic for you in your last cesarean I can’t necessarily make a recommendation for you to improve this cesarean, but here are some suggestions:

If the trauma was related to it being an emergency, think about how you could make it less traumatic by making it scheduled, planned, calm, & slow. Watch videos of “Gentle Cesareans” and see if this seems do-able to you. Say to your provider, “I need to figure out how to make this an emotionally, as well as physically, safe birth for me. How can you help me to make this a gentle, calm, smooth cesarean?”

If the trauma was related to the physical feelings (not enough anesthesia, feeling nauseous/vomiting, etc) talk to your provider ahead of time to make a firm plan to prevent this. For example, get an agreement from your provider that they will not start the cesarean until you are totally numb, or a plan to start the surgery with the right medications to prevent nausea and vomiting.

Talk to your provider about having a partner, doula, parent, friend, or sibling at the bedside with you for the whole procedure, to be your support person.

I always recommend therapy - if you haven’t been talking to a therapist about your prior delivery, I strongly recommend trying it. Make a support plan with your therapist to improve your emotional experience during the cesarean.

Sending you so much love and light

#cesarean section #cesarean birth #birth #labor and delivery #tolac #trial of labor after cesarean #vbac #vaginal birth after cesarean #repeat cesarean section #c/section #c section #gentle cesarean #trauma after delivery

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